CC EXAM Flashcards
A hazard symbol with three circles arranges in a triangle connected by a circle in the middle.
A. Radioactive hazard
B. Health Hazard
C. Flammable Hazard
D. Biohazard
Biohazard
What is the conversion factor used in Glucose from mg/dL to mmol/L.
A. 0.0555
B. 0.01113
C. 10
D. 2.14
0.0555
It is the unit used for the amount of substance
A. m
B. kg
C. s
D. mol
mol
What is the meaning of “R” in RACE in Fire Safety
A. Run
B. Recess
C. Rescue
D. Retrieve
Rescue
RESCUE
ALARM, CONTAIN,
EXTINGUISH
PULL,
AIM,
SQUEEZE,
SWEEP
A solution that has a transmittance of 1.0%T
would have an absorbance of:
A. 1.0
B. 2.0
C. 1%
D. 99%
2.0
*Beer’s Law states that the concentration of a chemical solution is directly proportional to its absorption of light. Transmittance is inversely
proportional to the absorbance.
Absorbance = 2–log (%T)
Absorbance = 2–log(1)
Absorbance = 2–0
Absorbance = 2
It isolates specific or individual wavelength of light.
A. Light source
B. Entrance slit
C. Monochromator
D. Exit slit
Monochromator
- Light source: Provides polychromatic light
- Entrance Slit: Minimizes unwanted or stray light
- Monochromator: It isolates specific or individual wavelength of light.
- Exit slit: Control the width of light beam (bandpass)
- Cuvette: Holds the solution to be measured
- Photodetector: Detects and converts transmitted light into photoelectric energy.
- Meter or Read-out device: Displays output of the detection system
Control values that are far from the main set of values.
A. Outliers
B. Trend
C. Shift
D. None of the Above
Outliers
*
Trend – Progressive drift of values to ONE SIDE of the mean
Shift- Abrupt change in the mean
Outliers- Control values that are far from the main set of values
Which of the following are the examples of
RANDOM ERROR:
I. Variation in handling techniques
II. Variation in operators
III. Temperature of analyzer
IV. Instability of instrument
A. I and II only
B. I, II and III only
C. I and III only
D. All of the above
All of the above
*
Random error – error that varies from one measurement to the next; occurs by CHANCE and has no means of predicting it.
Systematic error- error that influences observations consistently in ONE DIRECTION
It is the type of solution that contains several analytes with known concentration.
A. Standard
B. Control
C. Blank
D. None of the above
Control
*
Standard – it contains only 1 analyte with known concentration. Calibration and Reference
Control- it contains several analytes with known concentration. Ensures correct results
It is used to check the accuracy of test performed.
A. T test
B. F test
C. Variance
D. Delta check
T test
SPF – SD, Precision, F-test
MAT- Mean, Accuracy, T-test
Variance- measures the average degree to which each point differs from the mean.
Delta check- is a process to detect discrepancies in patient test results prior to reporting by
comparing current patient values to previous ones.
What is the confirmatory method for measuring drug of abuse
A. TLC
B. GC-MS
C. EMIT
D. HPLC
GC-MS
The ion selective membrane used to measure potassium is made of:
A. Polyvinyl chloride dioctyl phenyl phosphate ion exchanger
B. Valinomycin gel
C. High-borosilicate glass membrane
D. Calomel
Valinomycin gel
Which electrolyte measurement is least affected by hemolysis?
A. Phosphorus
B. Calcium
C. Potassium
D. Magnesium
Calcium
Mnemonics by Sir Jed:
* Na K
* Ca Fe
* PISO - Potassium Inside, Sodium Outside
* PICO- Phosphate Inside, Chloride Outside
Which of the following conditions involving electrolytes is described correctly.
A. Hypercalcemia may be induced by low serum magnesium
B. Potassium levels are slightly higher in heparinized plasma than in serum
C. Pseudohyponatremia occurs only when undiluted samples are measured
D. Hypoalbuminemia causes low total calcium but does not affect ionized calcium
Hypoalbuminemia causes low total calcium but does not affect ionized calcium
*When serum albumin is low, the equilibrium between bound and Cai is shifted, producing
increased Cai . This inhibits release of PTH by negative feedback until the Cai level returns to normal. Potassium is released from platelets and
leukocytes during coagulation, causing serum levels to be higher than plasma.
Pseudohyponatremia is a measurement error caused by diluting samples containing excessive fat or protein. The colloids displace plasma water, resulting in less electrolytes being delivered into the diluent. Only ion-selective electrodes that measure whole blood or undiluted serum are unaffected. Magnesium is needed for release of PTH, and PTH caused released of calcium and magnesium from bone. Therefore, hypocalcemia can be associated with either magnesium deficiency or magnesium excess.
Which electrolyte has an inverse relationship with bicarbonate in order to maintain electric neutrality.
A. Sodium
B. Phosphate
C. Chloride
D. Potassium
Chloride
Functions of Chloride: Maintenance of electrical neutrality in the body, Helps maintain serum osmolality & water balance, has an inverse
relationship with bicarbonate (it exchanges with Bicarbonate (HCO3) when it leaves the cell).
To maintain electrical neutrality a negative ion has to move into the cell OR a positive ion has to move out with the bicarbonate ion.
An analytical test using a device, tool or equipment with a different chemical or physical
principle that is more specific which will validate the result from the initial tests.
A. initial and confirmatory test
B. screening test
C. screening and initial test
D. confirmatory test
confirmatory test
- Screening: High degree of
sensitivity; Prone to false negatives - Confirmatory: High degree of
specificity
Reference method for Calcium:
A. Nephelometry
B. Atomic Absorption Spectrophotometry
C. Turbidimetry
D. Flame Emission Photometry
Atomic Absorption Spectrophotometry
AAS- it is used for measurement of unexcited trace metals (calcium and magnesium)
FEP- it is used in the measurement of the excited ions (sodium and potassium)
Turbidimetry- It determines the amount of light blocked by a particulate matter in a turbid
solution. It is best in protein measurements, detecting microbial growth in broth culture, antimicrobial test (broth method) and in detecting clot formation.
Nephelometry- It determines the amount of light scattered by a particulate matter suspended in a turbid solution. It is used for measuring the amount of antigen-antibody complexes (proteins)
NRL for drug testing
A. EAMC
B. NKTI
C. RITM
D. SACCL
EAMC
A trough blood sample for routine therapeutic drug monitoring is usually obtained:
A. Just before the next dose.
B. Just after a dose is administered.
C. At the calculated peak time after a dose
D. One half-life after a dose is administered
Just before the next dose.
Trough concentration- it is a lowest concentration of a drug obtained in the dosing
interval. Obtained just before the next dose
Peak concentration- it is a lowest concentration of a drug obtained in the dosing interval. Obtained after 1 hour of administration except “digoxin” 8 hours.
Screening test, except:
A. EMIT
B. ELISA
C. TLC
D. GC-MS
GC-MS
GC-MS- it is the GOLD STANDARD in drug testing
for identification and quantitation of drugs in body fluids.
TLC- it is a semiquantitative drug screening test.
EMIT- it is a screening test for therapeutic and prohibited drugs.
ELISA- screening test for HIV
It is the ability of the analytical method to measure the smallest amount of analyte being detected.
A. Practicability
B. Diagnostic Sensitivity
C. Analytical Sensitivity
D. Analytical Specificity
Analytical Sensitivity
Sensitivity- it is the ability of an analytical method to measure the smallest concentration
of the analyte of interest
Specificity- it is the ability of an analytical method to determine only the analyte of interest.
Practicability- it is the degree by which a method is easily repeated
Diagnostic specificity – it is the ability of the analytical method to detect the proportion of individuals without the disease.
Diagnostic sensitivity – It is the ability of the analytical method to detect the proportion of individuals with the disease.
Red color in biosafety means:
A. Stop
B. Be careful
C. Caution
D. Radiation hazard
Stop
What should be done first in a blood spill?
A. Add freshly prepared 10% chlorine solution
B. Use disposable paper towels to absorb
C. Let it dry then wash with water
D. Wash with warm water
Use disposable paper towels to absorb
*First, use disposable paper towels to absorb then add freshly prepared 10% chlorine solution.
Best advice to give to an elderly woman that is asked to fast for a test
A. Drink water
B. Exercise lightly
C. She can eat small meals
D. Breath regularly
Drink water
Fasting
-Fasting requirement is between 8 to 12 hours.
-TAGS – 10 to 12 hours
-OGTT- 8 to 14 hours is acceptable
-Atleast 8 hours before the test no excersie.
It is known to give the best visualization of QC data
A. LJ chart
B. Youden twin plot
C. Gaussian curve
D. CUSUM
LJ chart
Shewhart Levey Jennings Chart (aka. DOT CHART)
- It is the most widely used QC chart in clinical laboratory
- It easily identifies random and systematic error
- It is a graphic representation of the acceptable limits of variation in the results of an analytical method.
- It is best for internal laboratory quality control Youden twin plot
-It is used to compare results obtained on a high and low control serum from different
laboratories
-It is best for calibration and reagent preparation error. It detects random and systematic error Gaussian Curve
-It occurs when the data set can be accurately described by the SD and mean. It detects random
and systematic error
-It focusses on the distribution or errors from the analytical method rather than the values from healthy or patient population. CUSUM (aka. SIDEWAY)
- It calculates the difference between QC results and the target means
-Common method: V-mask
-This plot will give the earliest indication of systematic errors (trend) and can be used with
the 13s
Most popular and versatile automated analyzer
A. Continuous Flow Analyzer
B. Centrifugal Analyzer
C. Discrete Analyzer
D. Technicon Analyzer
Discrete Analyzer
Continuous Flow
-Sample flow through a common vessel or pathway. Liquids are pumped through a system of continuous tubing. Air bubbles serve as separating and
cleaning media.
Discrete Analysis
- Each sample-reagent mixture is handled separately in its own reaction vessel. Employs a variety of syringe pipettes to aspirate and dispense sample 2-6uL and reagents. Capable of running multiple test one sample at a time. Allows STAT samples to be easily accessed
Centrifugal Analysis
- Uses the force generated by
centrifugation to transfer specimens and reagents. Uses acceleration and deceleration of rotor to transfer the reagents and sample. For mixing centrifugal force (rotor) is utilized or bubbling of air. Advantage: Batch analysis
True for Delta Bilirubin
A. It is unconjugated bilirubin tightly bound to albumin
B. It has a longer half-life than other form of bilirubin
C. It is calculated on neonatal patients
D. It does not react with diazo reagents
It has a longer half-life than other form of bilirubin
Delta Bilirubin
* It is conjugated bilirubin tightly bound to albumin.
* It has a longer half-life than other forms of bilirubin
* It is formed due to prolonged elevation of conjugated bilirubin in biliary obstruction
* It reacts with diazo reagent in the direct bilirubin assay.
Detects the frequency of erroneous results
A. Pareto chart
B. Six Sigma
C. ISO 9001:2015
D. Lean System
Six Sigma
Six Sigma – It is a performance improvement program in which the goal is to improve the process by eliminating variations or errors. It is a tool that can be used to reduce laboratory
errors, increase productivity, and improve quality in the clinical laboratory.
Lean system- It is a system for reducing waste (non-valued activities) especially in production or manufacturing processes.
Six sigma except:
A. Improving accuracy of results
B. Identifying and solving erroneous results
C. Reducing TAT
D. Replacing erring MT staff
Reducing TAT
Indicators of the Improvement program:
-Improved performance
-Improved quality
-Improved bottom line
-Improved customer satisfaction
-Improved employee satisfaction
It is the most commonly used method for measuring the changes in colligative properties
of a solution.
A. Freezing point depression
B. Boiling point
C. Osmotic Pressure
D. Vapor pressure
Freezing point depression
What is the ACCEPTABLE SD range?
A. +/- 1SD
B. +/ - 2SD
C. +/- 3SD
D. +/-4SD
+/ - 2SD
-The acceptable reference limit is set at +/- 2SD
-Some laboratories use the 2s as a warning limit and 3s as an error limit.
-When the values exceed 2s = values are dispersed. If the values are close to each other the SD is less than 2s.
-1s to +1s 68.27%
-2s to +2s 95.45% (BASIS)
-3s to +3s 99.73%
Which of the following is not included in proficiency testing?
A. Analysis of the unknown samples should be completed and reported within 48 hours
B. Unknown samples must be tested using the same reagents and equipment for actual patient specimens
C. Unknown samples should be processed and treated like a patient
D. It allows each participating laboratory to compare and evaluate test results with those laboratories that use the methods after the testing period.
Analysis of the unknown samples should be completed and reported within 48 hours
External QC – it involves proficiency testing programs that periodically provide samples of unknown concentration to participating clinical laboratories. Unknown samples should be completed within the usual time as for the
routine samples. Unknown samples should be processed and treated like a patient specimen to determine the true essence of accuracy.
What is the ideal concentration of the buffer in serum protein electrophoresis.
A. pH 5.2
B. pH 6.5
C. pH 7.4
D. pH 8.6
pH 8.6
*Electrophoresis- Migration of charged particles in an electric field. Buffer: Barbital (pH 8.6) aka. Veronal
In electrochemistry, it is a type of pH electrode with a sodium bicarbonate buffer utilized in the measurement of carbon dioxide.
A. Clark
B. Valinomycin
C. Calomel
D. Severinghaus
Severinghaus
Severinghaus – pCo2 Electrode
Valinomycin gel- potassium
Calomel electrode- chloride
Clark- Po2
Intense fist-clenching results in sudden high concentration of this metabolic product.
A. Creatinine
B. Ammonia
C. Lactate
D. Pyruvate
Lactate
Tourniquet Application
-For accurate measurement of lactate, tourniquet should not be applied, and the patient should not clench his fist at the time of blood draw.
A blood sample for this assay should not be drawn after physical exercise otherwise the plasma concentration may be falsely decreased.
A. Somatotropin
B. Ammonia
C. Glucose
D. Lactate
Glucose
Glucose is utilized by the body therefore it decreases. Since glucose is released, the body will compensate, it will release cortisol (hyperglycemic hormone). Somatotropin is also known as growth hormone which is a hyperglycemic hormone that promotes glycolysis and glycogenolysis. Muscle is rich in lactate (lactate dehydrogenase) therefore it increases.
This tube is used in the analysis of glycosylated hemoglobin.
A. Royal blue top
B. Orange top
C. White pearl top
D. Purple top
Purple top
Royal blue- Trace elements toxicology nutritional studies and TDM
Orange- General chemistry
White pearl-
molecular diagnostics
Purple- hematology and glycated hemoglobin
The following statements are true regarding blood collection except:
A. When blood is put into a vacuum tube with a narrow needle, red blood cells are
destroyed.
B. If blood pressure cuff is used as a tourniquet, it is inflated to 60mmHg
C. Blood sample collected in an additive tube can be transferred to another tube of the same kind.
D. The gauge of the needle is inversely related to the size of the needle.
Blood sample collected in an additive tube can be transferred to another tube of the same kind.
A 42 year old female patient with loss of consciousness was presented to the emergency
room. She has diabetes mellitus and is currently under insulin therapy. She was about to report to work when she suddenly lost her balance and fell on the floor. Which of the following tests should be prioritized immediately to assess her condition?
A. Glycosylated hemoglobin
B. Random blood sugar
C. 2-hour OGTT
D. Fasting plasma glucose
Random blood sugar
*RBS it is requested during insulin shock and hyperglycemic ketonic coma.
If after 9-hour fasting the plasma glucose level of a non-pregnant woman is 117mg/dL, how will you categorize the patient?
A. Non-diabetic
B. Impaired glucose
C. With history of gestational diabetes
D. A starting diabetes mellitus
Impaired glucose
Non-Diabetic
(Prediabetes adult) - 70-99mg/dL
Impaired Plasma
Glucose (IPG) - 100-125 mg/dL
Diabetes mellitus - ≥126 mg/dL
It is the most specific method in measuring glucose in body fluids
A. Polarographic glucose oxidase
B. Hexokinase
C. O-toluidine
D. Glucose dehydrogenase
Hexokinase
*Hexokinase – it the most specific enzymatic method for glucose determination. It is a routine method for measurement of glucose. Hexokinase is not affected by the presence of ascorbic acid and uric acid.
It is a reflection of short-term glucose control over a period of 2 to 3 weeks.
A. HBA1C
B. Fructosamine
C. 1, 5 anhydroglucitol
D. None of the above
Fructosamine
- Glycosylated Hemoglobin – It reflects the average blood glucose level over the previous of 2 to 4 months.
- Fructosamine - It is a reflection of short-term glucose control over a period of 2 to 3 weeks.
- 1, 5 anhydroglucitol – it reflects 1 to 2 weeks post-prandial glycemia
At what concentration of serum triglyceride will it start to cause interference in the quantification of other bioanalytes?
A. 200mg/dL
B. 300mg/dL
C. 400mg/dL
D. 500mg/dL
400mg/dL
Lipemia- it occurs when serum triglyceride exceeds 4.6mmol/L (400mg/dL). The serum appears milky. It scatters light and eventually blocks the transmission of light. Correction action would be blanking technique and dual wavelength reading.
What type of tube should not be used for therapeutic drug monitoring?
A. Yellow top
B. Light blue top
C. Green top
D. Lavender top
Yellow top
- Clinical Chemistry Review Handbook for Medical Technologist by Rodriguez 2022 78 Blood samples for therapeutic drug monitoring should not be collected in tubes
with gel separator or serum separator tubes because some gels absorb drugs causing
falsely low result.
Prior to blood collection, the patient should be in a stable posture for atleast _____ minutes to prevent variations of results.
A. 5mins
B. 15mins
C. 30mins
D. 45mins
15mins
Patient should be seated/supine for at least 15 to 20 minutes before blood collection to prevent hemodilution or hemoconcentration.
Current NCEP guidelines (lipid test) : Patient should be seated for 5 minutes before sampling
to prevent hemoconcentration. 50% of lipid will lost after abrupt position change.
For better diagnosis and correlation of the current health condition, the patient should be advised to avoid dietary changes ____ hours before sampling.
A. 2hrs
B. 6hrs
C. 12hrs
D. 24hrs
24hrs
Diet – patients should be encouraged to avoid making any dietary changes, drinking alcohol, or engaging in excessive exercise for atleast 24 hours before having their blood collected for laboratory testing.
At room temperature : Glycolysis decreases
glucose by ____ in normal uncentrifuged coagulated blood. At refrigerated temperature : Glucose is metabolized at the rate of about______
A. 2mg/dL/hour ; 7mg/dL/hour
B. 7mg/dL/hour ; 2mg/dL/hour
C. 7mg/dL/hour; 11mg/dL/hour
D. 11mg/dL/hour ; 7mg/dL/hour
7mg/dL/hour ; 2mg/dL/hour
At room temperature : Glycolysis decreases glucose by 7mg/dL/hour in normal
uncentrifuged coagulated blood. At refrigerated temperature : Glucose is metabolized at the rate of about 2mg/dL/hour
Whole blood fasting glucose level is ____ than serum or plasma glucose
A. 10 to 15 % higher
B. 5 to 10% higher
C. 5 to 10% lower
D. 10 to 15 % lower
10 to 15 % lower
Fasting glucose in whole blood is 10% to 15% lower than in serum or plasma. Good to know: CSF glucose concentration should be approximately 60% of the plasma concentrations.
Disease associated with the absence of glucose 6
phosphatase enzyme
A. Von Gierke
B. Pompe
C. Andersen
D. Cori-Forbes
Von Gierke
10% contamination with 5% dextrose will increase the glucose in a blood sample by
___mg/dL or more.
A. 100mg/dL or more
B. 200mg/dl or more
C. 400mg/dL or more
D. 500mg/dL or more
500mg/dL or more
Glucose concentration that will show observable symptoms of hypoglycemia:
A. 100 to 12mg/dL
B. 90 to 110mg/dL
C. 71 to 80 mg/dL
D. 50 to 55mg/dL
50 to 55mg/dL
64-70mg/dL
- Glucagon and other glycemic hormones are released to the circulation
50-55mg/dL
- Observable symptoms of hypoglycemia appear
≤50mg/dL
- Considered low value and abnormal for infants (requires
further diagnostic test)
<50mg/dL
- Impairment of cerebral functions starts
Which of the following differentiates type 1 diabetes mellitus from type 2 diabetes mellitus using fasting serum with the former having decreased or undetectable levels while the latter has a normal concentration.
A. Ketone test
B. A1C
C. Mixed Meal Tolerance
D. C-peptide
C-peptide
Type 1 DM
- B- cell destruction
- Decreased or undetectable C-peptide
- Autoantibodies (+)
- Ketosis: common
Type 2 DM
- Insulin resistance
- Detectable C-peptide
- Autoantibodies (-)
- Ketosis: rare
What is described as an abnormal lipoprotein found in patients with obstructive biliary disease?
A. LpX
B. B-VLDL
C. IDL
D. Floating B-lipoprotein
LpX
Lipoprotein X
-It is an abnormal lipoprotein found in obstructive jaundice and LCAT deficiency
-It is a specific and sensitive indicator of cholestasis
It contains ApoC and Albumin
If the serum cholesterol concentration is 352mg/dL what is the equivalent SI value?
A. 9.2 mmol/L
B. 92 mmol/L
C. 21.8 mmol/L
D. 352 mmol/L
9.2 mmol/L
352 X 0.026 (conversion factor of cholesterol) = 9.2 mmol/L
The concentration of this apolipoprotein is directly related to the development of
atherosclerosis.
A. Apo-A1
B. ApoB-48
C. Apo-B100
D. ApoE
Apo-B100
What is the reference method in measuring serum triglyceride?
A. Abell, Levy and Brodie (cdc reference method for cholesterol)
B. Modified Van Handel and Zilversmith
C. Liebermann and Burchardt (cholesterol)
D. Bloor’s method
Modified Van Handel and Zilversmith
Triglyceride (TAG)
Chemical Method:
Colorimetric Method (Van Handel and Zilversmith)
Fluorometric Method (Hantzsch Condensation)
Enzymatic Method :
Glycerol Kinase
CDC Reference method :
Modified Van Handel and Zilversmith
Uniform turbidity in refrigerated serum indicates
an elevated concentration of which lipoprotein and lipid?
I. Chylomicron
II. Pre beta lipoprotein
III. Dietary triglyceride
IV. Endogenous Triglyceride
A. 1,4
B. 2,3
C. 1,3
D. 2,4
2,4
Chylomicron – creamy top layer
VLDL – turbid
Chylomicron and VLDL – creamy top layer and turbid bottom
Which of the following is not true regarding cholesterol?
A. Aldosterone and estrogen are derived from cholesterol
B. It is the third major lipid in plasma
C. Elevated concentration may lead to myocardial infarction
D. 85% of plasma cholesterol is from the liver
It is the third major lipid in plasma
1st most abundant lipid- Phospholipid
2nd most abundant lipid– Cholesterol
3rd most abundant lipid– Triglycerides
What is Fridewald Equation
A. LDL=TC-(HDL + TG/6)
B. TC=LDL-(HDL+TG/5)
C. HDL=TC-(LDL+TG/6)
D. LDL=TC-(HDL+TG/5)
LDL=TC-(HDL+TG/5)
*Good to know:
Friedewald Formula for LDL-C:
TC-HDL-VLDL
Friedewald Formula for VLDL:
VLDL : TAG/ 2.175 = mmol/L
VLDL: TAG/ 5.0=mg/dL
*not valid for TAG >400mg/dL
In familial hypercholesterolemia, the hallmark finding is an elevation of
A. CM
B. LDL
C. HDL
D. B-VLDL
LDL
I – Hyperchylomicronemia (Familial LPL deficiency) CHYLOMICRON
II a – Familial Hypercholesterolemia (Highest
cardiac risk) LDL
II b – Familial Combines Hyperlipidemia, Mixed defect, High cardiac risk LDL AND VLDL
III – Familial dysbetalipoprotenemia B-VLDL/
Floating B-Lipoprotein IDL AND B-VLDL
IV- Familial Hypertriglyceridemia TAG AND VLDL
V- Familial Hyperlipoprotenemia TAG, CHOLE, VLDL AND CHYLOMICRON
It is also known as the “sinking pre beta lipoprotein”, associated with a higher risk for
atherosclerosis:
A. Beta VLDL
B. LpX
C. Lp(a)
D. IDL
Lp(a)
Minor lipoproteins
IDL- product of VLDL catabolism “VLDL” remnant
Lp(a) – sinking pre beta lipoprotein, increased risk of atherosclerotic cardiovascular disease.
Abnormal lipoproteins:
LPX – obstructive jaundice and LCAT deficiency
B-VLDL – floating B lipoprotein, found in type III
hyperlipoproteinemia
Hypertriglyceridemia with values >500mg/dL may be observed in this condition
A. Myocardial infarction
B. Recurrent pancreatitis
C. Nephrotic syndrome
D. Type 1 diabetes
Recurrent pancreatitis
Reference range
(normal) <150mg/dL
Borderline High 150-199 mg/dL
High TAG
200-499mg/dL
> 50mg/dL
Very High TAG (acute and recurrent pancreatitis)
This is also known as biliprotein?
A. Conjugated bilirubin
B. Unconjugated bilirubin
C. Delta bilirubin
D. None of these
Delta bilirubin
Delta bilirubin
-It is the conjugated bilirubin tightly bound to albumin
-It is formed due to prolonged elevation of conjugated bilirubin in case of biliary obstruction
Which of the following is (are) not acute-phase reactant(s)?
A. Alpha 1 acid glycoprotein
B. Alpha 1 anti-trypsin
C. C-reactive protein
D. Alpha-fetoprotein
Alpha-fetoprotein
Negative Acute Phase Reactant
“ PAT “ – Prealbumin, Albumin, Transferrin
All protein fractions are acute phase reactant
except: AFP, Gc-Globulin, Inter-alpha-trypsin inhibitor, Thyroxine binding globulin, Alpha 2 macroglobulin, B2 microglobulin
This protein appears in urine when reabsorption is incomplete because proximal tubular damage as seen in acute kidney injury:
A. Ceruloplasmin
B. Alpha 2 maroglobulin
C. Beta 2 microglobulin
D. Pre albumin
Beta 2 microglobulin
Beta 2 microglobulin (B2M) – it is freely filtered at the glomerulus, and then is reabsorbed and
completely metabolized by the proximal tubule. Elevated plasma levels are the result of impaired clearance by the kidneys or over production of
proteins as seen in inflammatory diseases (RA and SLE). Its presence in the urine denotes
proximal tubular damage, as in acute kidney injury, that is, when reabsorption is incomplete.
Which of the following are tests to measure the hepatic synthetic ability:
I. Serum albumin
II. Ammonia
III. Coagulation factors
IV. Bilirubin
A. 1 and 2
B. 1 and 3
C. 1, 2, 3
D. 4 only
1 and 3
Liver Functions:
* Synthetic – synthesis of enzymes, clotting factors, lipoproteins
- Conjugation- conjugation of bilirubin
- Detoxification and Drug metabolism- drug metabolism; conversion of ammonia to urea
- Excretory and secretory function- Excretion of bile
- Storage function- Storage for glycogen, storage sites for all fat soluble and water soluble vitamins
Which statement regarding bilirubin metabolism is true?
A. Bilirubin undergoes rapid photo-oxidation when exposed to daylight
B. Bilirubin excretion is inhibited by barbiturates
C. Bilirubin excretion is increased by chlorpromazine
D. Bilirubin is excreted only as the diglucuronide
Bilirubin undergoes rapid photo-oxidation when exposed to daylight
*The sample must be protected from light exposure (fluorescent lamp, indirect sunlight) as it would cause significant reduction in the actual concentration of bilirubin and it should be analyzed within 2 to 3 hours after collection.
The major contributor to oncotic or osmotic pressure:
A. Prealbumin
B. Albumin
C. Alpha 2 macroglobulin
D. Alpha 1 antitrypsin
Albumin
Albumin
-It is a general transport protein (binds to various
substances in the blood)
-It maintains oncotic pressure.
-It is an indicator of nutritional status
Which of the following disorders is characterized
by an inability to transport bilirubin from the sinusoidal membrane into hepatocyte?
A. Gilbert syndrome
B. Dubin johnson syndrome
C. Crigler-najjar syndrome
D. Lucey-driscoll syndrome
Gilbert syndrome
- Glibert’s syndrome : Bilirubin Transport Deficit
- Criggler-najjar syndrome: Conjugation deficit
- Dubin-johnson syndrome: Bilirubin excretion deficit
- Lucey-driscoll syndrome: Conjugation inhibitor
It is secreted in the cardiac ventricles; a significant measure of congestive heart failure; confirms if shortness of breath and fatigue are due to heart failure; secreted in response to
cardiac wall stress; a cardiac hormone
A. NT-proBNP
B. BNB
C. ANP
D. Troponin
BNB
- Trop I – AMI
- Trop T- Unstable angina
- B-type Natriuretic Peptide – It is a diagnostic marker for congestive heart failure; when heart is damaged, the body secretes high levels BNP into the blood stream to try to ease the strain of the heart
- NT-proBNP – it monitors heart failure
- Myoglobin – marker for chest pain (angina) and early detection of AMI
Elevated serum levels of this plasma protein in renal transplant patients indicates organ rejection
A. Ceruloplasmin
B. Alpha 2 macroglobulin
C. Troponin C
D. B2 microglobulin
B2 microglobulin
Beta 2 microglobulin
-It is a light chain component of the major leukocyte antigen (HLA) encoded by the B2M gene.
-it is found on the surface of most nucleated cells, present in high concentration on lymphocytes
Which of the following conditions is associated with “β-γ bridging”?
A. Multiple myeloma
B. Malignancy
C. Hepatic cirrhosis
D. Rheumatoid arthritis
Hepatic cirrhosis
*Hepatic cirrhosis produces a polyclonal gammopathy associated with a high IgA level.
This obliterates the valley between β and γ zones. Malignancy and rheumatoid arthritis produce polyclonal gammopathies classified as
chronic inflammatory or delayed response patterns. Multiple myeloma produces a zone of restricted mobility usually in the γ, but sometimes in the β- or α2-region
In bacterial infection, increased plasma levels is observed compared to viral infection, hence it may be used as a rapid differential test in the
assessment of COVID-19.
A. Albumin
B. Haptoglobin
C. Alpha 1 antitrypsin
D. CRP
CRP
C-Reactive Protein
-It is used as a rapid test for presumptive diagnosis of bacterial infection versus viral infection.
Increased levels of this protein in maternal serum are seen in spina bifida, and neural tube
defects:
A. AFP
B. Alpha 1 anti trypsin
C. Haptoglobin
D. Orosomucoid
AFP
Maternal serum AFP is used as a screening test for any fetal abnormal conditions; it detects neural tube defects (NTDs) and Down Syndrome (DS)
In kidney disease, which NPN is the first to be elevated in plasma?
A. Urea
B. Creatinine
C. Uric acid
D. Ammonia
Urea
*Blood Urea Nitrogen
-It is the first metabolite to elevate in kidney disease.
Given the following data, compute the creatinine
clearance of a 34 year old female patient in ml/minute
Serum creatinine= 1.68mg/dL
Urine creatinine= 82g/dL
Urine volume= 935mL
Body Surface Area=1.68
A. 32.6
B. 26.8
C. 14.56
D. 0.0137
32.6
Clearance ml/min = (U/P) X (Vol. in mL/ Minutes) X (1.73/ A)
(82/1.68) X (935/1440) X (1.73/1.68) = 32.64
__a single marker to diagnose renal failure; ___test to assess the renal tubular integrity
A. Urea, Creatinine
B. Creatinine, Urea
C. B2 microglobulin, creatinine
D. Creatinine, B2 microglobulin
Creatinine, B2 microglobulin
*Clue:
Renal tubular failure- Reabsorption
Renal Function- Excretion
Creatinine- It is commonly used to monitor renal function; an index of overall renal function
B2 microglobulin- 100% reabsorbed
Endogenous substance used as alternative test for creatinine clearance to screen for kidney
dysfunction
A. Cystatin C
B. B2 microglobulin
C. Inulin Clearance
D. Radioisotopes
Cystatin C
Cystatin C
– It has been included in the list of endogenous renal marker owing to its sensitivity for
determining the glomerular filtration rate
-It has been proposed as an alternate test for serum creatinine and creatinine clearance test to screen and monitor kidney dysfunction
A 19 year old male patient with jaundice has the following lab results:
B1= normal
B2= elevated
Urine bilirubin = positive
These results indicate:
A. Malaria, anemia, prehepatic jaundice
B. Cirrhosis, obstructive jaundice (hepatic)
C. Cholelithiasis, post hepatic jaundice
D. Hepatitis A, hepatic jaundice (high
Cholelithiasis, post hepatic jaundice
*Pre hepatic jaundice:
B1 (increased)
B2 (Normal)
Urobiliogen (normal)
Post hepatic :
B1 (Normal)
B2 (Increased)
Urobilinogen (Decreased)
Urine bilirubin (Positive)
Hepatocellular combined jaundice :
B1 and B2 (Increased) Urobilinogen (Decreased)
Urine bilirubin (positive)
The presence of this supplement in serum affects
immunoassay, hence, it is included in patient pre-sampling inquiry and should be written in the requisition form
A. Vitamin B7
B. Vitamin C
C. Vitamin E
D. Gluthathione
Vitamin B7
Pellagra is associated with deficiency of which of the following vitamins?
A. A
B. B1
C. B2
D. Niacin
Niacin
- Vitamin A (Retinol) – night blindness
- Vitamin B1 (thiamine) – beri beri
- Vitamin B2 ( Riboflavin) – Angular stomatitis, cheilosis, glossitis
- Vitamin B3 (Niacin) - Pellagra
Heroin is synthesized from what drug?
A. Diazepam
B. Morphine
C. Argonine
D. Chlorpromazine
Morphine
*Morphine – most powerful anti-pain; metabolite or heroin
A drug that relaxes the smooth muscle of the bronchial passage is:
A. Acetaminophen
B. Lithium
C. Phenytoin
D. Theophylline
Theophylline
*Used to treat asthma and COPD; administered orally
For every 1C increase in temperature above 37C, what are the expected values of PO2 and PCO2, respectively
A. Decreased by 7% and increase by 3%
B. Increases by 7% an decreases by 3%
C. Decreases by 3% and decreases by 7%
D. Increases by 7% and increases by 7%
Decreased by 7% and increase by 3%
Factors affecting blood gases and pH measurement:
- Temperature (37+/- 0.1) – For each degree fever in the patient, PO2 will fall 7% and
pCO2 will rise 3% - Elevated Plasma Portein Concentrations – pO2 test is affceted by build up of proteins
on the surface of the membrane - Bacterial contamination within the measuring chamber, if present, will consume oxygen and cause low value of pO2
- Improper Transport of the blood specimen- when blood samples are not transported on ice (during transpor to an another laboratory), the pO2 changes more sapidly than pH and pCO2. Samples should be analyzed immediately in less than 30 minutes after blood collection.
A patient blood gas results are:
pH= 7.50
pCO2 =55mmgHg
HCO3=40mmol/L
What is indicated by these laboratory results?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Metabolic alkalosis
Low temperature storage prior to testing will cause:
A. Decreased LD4, LD5 and ALP
B. Decreased LD4, LD5 and increased ALP
C. Increased LD4, LD5 and ALP
D. Increased LD4 and LD5 and decreased ALP
Decreased LD4, LD5 and increased ALP
LD 4 and LD5 : are labile in cold which is in contrast to most enzymes which are more stable
when refrigerated or frozen.
ALP: is sensitive if stored at low temp. (4C) False increase.
Which of the following enzymes is considered most tissue specific?
A. Creatinine Kinase
B. Amylase
C. Alkaline phosphatase
D. Alcohol dehydrogenase
Alcohol dehydrogenase
- ALP- non-specific enzymes capable of reacting with many different substrates (Liver, Bone, Plaental, Intestinal)
- Amylase- S-type (ptyalin) and P-type (amylopsin); earliest pancreatic marker. “Lipase” is the most specific pancreatic
marker - Creatinine kinase-
CK-BB (brain, intestine, smooth muscle),
CK-MM (Cardiac and Skeletal) , CK-MB (MI) - Alcohol dehydrogenase- liver specific
Principle of enzyme data interpretation:
I. There is no truly organ- specific enzyme
II. Serial measurements provide most useful data; a single measurement can be misleading
III. Negative results are useful
IV. Enzyme date must be integrated with other information
A. 1 and 3
B. 2 and 4
C. 1,2,3
D. 1 to 4
1 to 4
The higest elevations of ALP activity occurs in:
A. Rickets
B. Paget’s disease
C. Osteomalacia
D. Hyperparathyroidism
Paget’s disease
This is an inflammatory enzyme marker that is located in various human body organs and tissues; thus, it can be included in the COVID-19
biochemistry tests.
A. LD
B. CK
C. Aldolase
D. AST
LD
Conditions associated with respiratory acidosis:
I. COPD
II. Pneumonia
III. Myasthenia gravis
IV. Anxiety
A. 1 and 3
B. 2 and 4
C. 1,2,3
D. 1 to 4
1,2,3
Thyroid hormones are derived from which of the following:
A. Histidine
B. Cholesterol
C. Tyrosine
D. Phenylalanine
Tyrosine
*TSH stimulates the synthesis of thyroid hormones; Iodine is the most important element in the synthesis.
Tyrosine +Iodine = MIT and DIT
MIT + DIT = T3 or DIT + DIT = T4
A patient has signs and symptoms suggestive of
acromegaly. The diagnosis would be confirmed if the patient had which of the following:
A. An elevated serum phosphate concentration
B. A decreased serum growth hormone releasing factor concentration
C. No decrease in serum growth hormone concentration 90 minutes after oral glucose
administration
D. An increased in serum somatostatin concentration
No decrease in serum growth hormone concentration 90 minutes after oral glucose administration
Screening test
- Somatomedin C or Insulin-like growth factor 1
Confirmatory test
- Glucose suppression test – OGTT 75g (glucose)
Metabolic alkalosis is characterized by a/an:
A. Excess carbon dioxide
B. Deficit or dissolved carbon dioxide
C. Excess bicarbonate
D. Deficit bicarbonate
Excess bicarbonate
The major carrier protein of T3 and T4 in the circulation are:
A. Albumin
B. Thyroglobulin
C. TBG
D. Thyroxine-binding prealbumin
TBG
*Thyroid hormone binding proteins
-TBG : principal carrier protein, it transports majority of T3 and T4
-Thyroxine-binding Pre-albumin: transports 15 to 20% of T4, T3 has no affinity for prealbumin
-Thyroxine-binding Albumin: transports T3 and 10% of T4
It is the biologically inactive metabolite of T4. It detects patients with euthyroid sick syndrome.
A. rT3
B. T3Uptake
C. FT4
D. TBG
rT3
The kober reaction is used in the assay of:
A. Urinary estrogen
B. Glucocorticoids
C. Testosterone
D. Epinephrine
Urinary estrogen
Kober reaction: Estrogen
Reagent: Hydroquinone-H2SO4
(+) Pink color
The disorder is characterized by
excessive production of norepinephrine:
A. Klinefelter syndrome
B. Cushing disease
C. Nephrogenic diabetes mellitus
D. Neuroblastoma
Neuroblastoma
Neuroblastoma:
-malignant tumor of the adrenal medulla that occurs in children. Increased of epinephrine and
norepinephrine along with dopamine.
-Urine: increases in VMA and HVA
-May also be quantified using HPLC, gas chromatography
